How, When, and Where to Get Care During the Holidays With TRICARE

12/19/2019

Decked your halls with injury and folly? With the hustle and bustle of the holidays, it’s easy to get distracted and experience a mishap. Whether you burn your finger frying latkes or crash your toboggan, your TRICARE health plan rules may be hard to recall if you need care over the holidays. Do your best to stay safe this holiday season. But just in case, refresh your knowledge now on how you can get the emergency or nonemergency help you need, whenever you need it.

Do you have an emergency?

An emergency threatens your life, limb, eyesight, or safety. Examples include severe bleeding, back injury, chest pain, or difficulty breathing. Other types of emergencies include maternity and psychiatric. TRICARE covers emergency care. If you’re admitted, you may need to get an authorization depending on the type of care you need.

If you reasonably think you have an emergency, go to the nearest emergency roomThe hospital department that provides emergency services to patients who need immediate medical attention. or call 911. If you’re overseas, call the emergency medical service for your area. If you’re enrolled in a TRICARE Prime plan, call your primary care manager or regional contractor within 24 hours of your visit.

Do you need urgent care?

You also have an option to visit an urgent care facility. Urgent care is care you need for a nonemergency illness or injury that requires treatment within 24 hours. This could be a high fever or sprained ankle. You should get urgent care before your condition becomes a serious risk to your health. Most TRICARE beneficiaries can visit an urgent care center whenever they need to without a referral. But if you go to an urgent care center, make sure you follow your plan’s rules for getting urgent care.

When possible, you should visit a TRICARE network provider or a TRICARE-authorized (network or non-network) urgent care center to reduce your out-of-pocket costs. If you’re a family member or retiree enrolled in TRICARE Prime and get urgent care from a non-network provider outside of a TRICARE-authorized urgent care center, you’ll have to pay point-of-service cost-shares. You can find TRICARE-authorized urgent care centers by searching your region’s provider directory. To find an overseas provider, search the overseas provider directory.

Active duty service members enrolled in TRICARE Prime or TRICARE Overseas Program Prime must visit military hospitals and clinics for urgent care. A referral is required for civilian urgent care. 

Do you need health care advice?

If you don’t have an emergency or you’re not sure if you need urgent care, you can use the Military Health System (MHS) Nurse Advice Line. You can chat, video chat, or talk on the phone with a registered nurse 24/7. The nurse can answer your health care questions and give you medical advice. You can also get help with scheduling an appointment within 24 hours at a military hospital or clinic, if available.

In the U.S., Guam, or Puerto Rico, call the MHS Nurse Advice Line at 1-800-TRICARE (1-800-874-2273) and choose option 1. For all other country-specific numbers, visit the MHS Nurse Advice Line website. You can only use this resource if you’re living or traveling in the U.S. or a country with an established military hospital or clinic.

Learn the difference between emergency and urgent care, and the rules for your TRICARE plan now. Remember costs differ based on who you are and your plan, so visit Health Plan Costs for information. That way, you’ll be able to make informed decisions should the need arise this holiday season.

 

Last Updated 6/23/2020